Individual
KATINA MALLORY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
621 RUSSELL DR, DAYTONA BEACH, FL 32114-5141
(386) 871-7368
Mailing address
621 RUSSELL DR, DAYTONA BEACH, FL 32114-5141
(386) 871-7368
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN9180804
FL
Other
Enumeration date
08/02/2019
Last updated
08/02/2019
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